Yes, I hear you CLC. Putting patients first and doing stuff, just to do stuff, are not necessarily the same thing. There are a number of things that make peds a bit of a different animal from adult care or even what someone may have gotten in a matter of weeks in a peds clinical rotation.
The thing we see with kids is that they can seem and by all general measurements be fine, and then BOOM! They start swirling the bowl--or rather, in less than an instant, they are alreading halfway down the drain.
This is a big difference, in general, from adult patients--even critically ill adult patients. They can tend to give you lead-in time about where they are going with their presenation, b/c their compensatory and homeostatic measures have learned" to gradually adjust to things over time.
Generally this is just not so with kids. You can never, EVER take their status for granted; b/c in less than a hiccup, they are in trouble, and everyone is like, "What the heck?" That's why I say the whole picture should be noted and documented with each kid whenever you are assessing or re-assessing them. It's not enough to just do vital signs on them. This is a big difference from adult acute and critical care. Kids often will not show you a trend in the same way an adult may. It's probably why those that work in peds should line their undies with panty protectors. I mean, many times it happens that fast.